El otro cuerpo de la identidad: análisis de modelos culturales de los trastornos del cuerpo femenino

Justificación: El presente estudio se centra en la construcción de la identidad corporal en la anorexia nerviosa, desde una perspectiva social y cultural y tiene en cuenta las aportaciones de diferentes autores desde la perspectiva feminista de la salud y desde la antropología, dado que ambos planteamientos adoptan una visión mas amplia de los trastornos mentales y proponen comprenderlos en el contexto del malestar en la cultura. Objetivo: Analizar y comparar las variables que configuran los modelos culturales en nuestra sociedad sobre la identidad femenina, construida sobre todo a partir de la corporalidad y a través de la experiencia de mujeres diagnosticadas de anorexia. Metodología: Investigación cualitativa. Las técnicas básicas utilizadas han sido las entrevistas en profundidad y la observación participante. Resultados: Tras el análisis de las entrevistas se evidenciaron diferentes categorías que se han agrupado en tres grandes apartados la percepción de la identidad, la percepción social del cuerpo y la aceptabilidad del propio cuerpo. Conclusión: Podríamos decir que los modelos de identidad femenina que plantea la sociedad respecto a la imagen ideal y a los medios para conseguirlo producen un conflicto del que resulta difícil escapar tanto a las mujeres catalogadas de normales, como aquellas diagnosticadas de anorexia nerviosa

Educational intervention for parents of adolescents with chronic illness: a pre-post test pilot study.

OBJECTIVE: This pilot experimental study tested the feasibility and intended effect of an educational intervention for parents to help them assist their adolescent child with chronic illness (CI) in becoming autonomous. METHODS: A two-phase pre-post pilot intervention study targeting parents of adolescents with CI was conducted. Parents were allocated to group 1 and 2 and received the four-module intervention consecutively. Intended effect was measured through online questionnaires for parents and adolescents before, at 2 months after, and at 4-6 months after the intervention. Feasibility was assessed through an evaluation questionnaire for parents. RESULTS: The most useful considered modules concerned the future of the adolescent and parents and social life. The most valued aspect was to exchange with other parents going through similar problems and receiving a new outlook on their relationship with their child. For parents, improvement trends appeared for shared management, parent protection, and self-efficacy, and worsening trends appeared for coping skills, parental perception of child vulnerability, and parental stress. For adolescents, improvement trends appeared for self-efficacy and parental bonding and worsening trends appeared for shared management and coping skills. CONCLUSION: Parents could benefit from peer-to-peer support and education as they support the needed autonomy development of their child. Future studies should test an online platform for parents to find peer support at all times and places.

El otro cuerpo de la identidad: análisis de modelos culturales de los trastornos del cuerpo femenino

Justificación: El presente estudio se centra en la construcción de la identidad corporal en la anorexia nerviosa, desde una perspectiva social y cultural y tiene en cuenta las aportaciones de diferentes autores desde la perspectiva feminista de la salud y desde la antropología, dado que ambos planteamientos adoptan una visión mas amplia de los trastornos mentales y proponen comprenderlos en el contexto del malestar en la cultura. Objetivo: Analizar y comparar las variables que configuran los modelos culturales en nuestra sociedad sobre la identidad femenina, construida sobre todo a partir de la corporalidad y a través de la experiencia de mujeres diagnosticadas de anorexia. Metodología: Investigación cualitativa. Las técnicas básicas utilizadas han sido las entrevistas en profundidad y la observación participante. Resultados: Tras el análisis de las entrevistas se evidenciaron diferentes categorías que se han agrupado en tres grandes apartados la percepción de la identidad, la percepción social del cuerpo y la aceptabilidad del propio cuerpo. Conclusión: Podríamos decir que los modelos de identidad femenina que plantea la sociedad respecto a la imagen ideal y a los medios para conseguirlo producen un conflicto del que resulta difícil escapar tanto a las mujeres catalogadas de normales, como aquellas diagnosticadas de anorexia nerviosa

El otro cuerpo de la identidad: análisis de modelos culturales de los trastornos del cuerpo femenino

Justificación: El presente estudio se centra en la construcción de la identidad corporal en la anorexia nerviosa, desde una perspectiva social y cultural y tiene en cuenta las aportaciones de diferentes autores desde la perspectiva feminista de la salud y desde la antropología, dado que ambos planteamientos adoptan una visión mas amplia de los trastornos mentales y proponen comprenderlos en el contexto del malestar en la cultura. Objetivo: Analizar y comparar las variables que configuran los modelos culturales en nuestra sociedad sobre la identidad femenina, construida sobre todo a partir de la corporalidad y a través de la experiencia de mujeres diagnosticadas de anorexia. Metodología: Investigación cualitativa. Las técnicas básicas utilizadas han sido las entrevistas en profundidad y la observación participante. Resultados: Tras el análisis de las entrevistas se evidenciaron diferentes categorías que se han agrupado en tres grandes apartados la percepción de la identidad, la percepción social del cuerpo y la aceptabilidad del propio cuerpo. Conclusión: Podríamos decir que los modelos de identidad femenina que plantea la sociedad respecto a la imagen ideal y a los medios para conseguirlo producen un conflicto del que resulta difícil escapar tanto a las mujeres catalogadas de normales, como aquellas diagnosticadas de anorexia nerviosa

Mood disorders in eating disorder patients: Prevalence and chronology of ONSET.

OBJECTIVES: In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. METHOD: The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. RESULTS: Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. LIMITATIONS: Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. CONCLUSION: Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

The difference of disease perception by juvenile idiopathic arthritis patients and their parents : analysis of the JAMAR questionnaire.

BACKGROUND: The JAMAR (Juvenile Arthritis Multidimensional Assessment Report) has been developed to evaluate the perception of the patient and his parents on different items: well-being, pain, functional status, quality of life, disease activity, disease course, side effects of medication, therapeutic compliance and satisfaction with illness outcome. Our aim was to compare disease's perception by JIA patients and their parents. METHODS: We included into the study 100 consecutive patients over 7 years of age. We asked both parent and child to complete the JAMAR questionnaire. For each patient we recorded demographic and disease related data. We examined the level of disagreement between children and parents for the quantitative items of the JAMAR: VAS Pain, VAS Disease Activity, VAS Well Being, Juvenile Arthritis Functional Score, HRQoL. Then we looked for a relation between discordance-rate and demographic and clinical variables. RESULTS: Children and parents' median scores for all five items were similar. Individual dyads agreement was low, with a large amount of pairs (80) discordant for at least one item. We found higher MD VAS and JADAS in more discordant dyads, suggesting that when the disease is more active discordance between child and parent increase. CONCLUSION: The JAMAR questionnaire is an important tool that helps clinicians to detect divergent child and parent's disease perceptions. It is essential that both patients and parents fill the JAMAR questionnaire for a complete clinical and psychosocial evaluation.

Hampaiston kuluminen

Tutkielma käsittelee hampaiden kulumista potilastapauksen avulla. Kyseessä on kirjallisuuskatsaus hampaiston eri kulumistyypeistä: eroosiosta, attritiosta, abraasiosta ja abfraktiosta, sekä myös niiden hoidosta ja ehkäisystä. Tutkielmassa käsitellään lisäksi hampaiston kulumisen etiologisia tekijöitä, joihin kuuluvat muun muassa syömishäiriöt Anorexia nervosa ja Bulimia nervosa. Katsauksessa käsitellään myös kuluneen purennan kuntouttamista asiantuntijahoidon avulla.

Food and the circadian activity of the hypothalamic-pituitary-adrenal axis

Temporal organization is an important feature of biological systems and its main function is to facilitate adaptation of the organism to the environment. The daily variation of biological variables arises from an internal time-keeping system. The major action of the environment is to synchronize the internal clock to a period of exactly 24 h. The light-dark cycle, food ingestion, barometric pressure, acoustic stimuli, scents and social cues have been mentioned as synchronizers or" zeitgebers". The circadian rhythmicity of plasma corticosteroids has been well characterized in man and in rats and evidence has been accumulated showing daily rhythmicity at every level of the hypothalamic-pituitary-adrenal (HPA) axis. Studies of restricted feeding in rats are of considerable importance because they reveal feeding as a major synchronizer of rhythms in HPA axis activity. The daily variation of the HPA axis stress response appears to be closely related to food intake as well as to basal activity. In humans, the association of feeding and HPA axis activity has been studied under physiological and pathological conditions such as anorexia nervosa, bulimia, malnutrition, obesity, diabetes mellitus and Cushing's syndrome. Complex neuroanatomical pathways and neurochemical circuitry are involved in feeding-associated HPA axis modulation. In the present review we focus on the interaction among HPA axis rhythmicity, food ingestion, and different nutritional and endocrine states

The validity and 4-year test-retest reliability of the Brazilian version of the Eating Attitudes Test-26

In a cross-sectional study conducted four years ago to assess the validity of the Brazilian version of the Eating Attitudes Test-26 (EAT-26) for the identification of abnormal eating behaviors in a population of young females in Southern Brazil, 56 women presented abnormal eating behavior as indicated by the EAT-26 and the Edinburgh Bulimic Investigation Test. They were each matched for age and neighborhood to two normal controls (N = 112) and were re-assessed four years later with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI). The EAT results were then compared to diagnoses originating from the CIDI. To evaluate the temporal stability of the two screening questionnaires, a test-retest design was applied to estimate kappa coefficients for individual items. Given the prevalence of eating disorders of 6.2%, the CIDI psychiatry interview was applied to 161 women. Of these, 0.6% exhibited anorexia nervosa and 5.6%, bulimia nervosa (10 positive cases). The validity coefficients of the EAT were: 40% sensitivity, 84% specificity, and 14% positive predictive value. Cronbach's coefficient was 0.75. For each EAT item, the kappa index was not higher than 0.344 and the correlation coefficient was lower than 0.488. We conclude that the EAT-26 exhibited low validity coefficients for sensitivity and positive predictive value, and showed a poor temporal stability. It is reasonable to assume that these results were not influenced by the low prevalence of eating disorders in the community. Thus, the results cast doubts on the ability of the EAT-26 test to identify cases of abnormal eating behaviors in this population.

Hampaiston kuluminen

Tutkielma käsittelee hampaiden kulumista potilastapauksen avulla. Kyseessä on kirjallisuuskatsaus hampaiston eri kulumistyypeistä: eroosiosta, attritiosta, abraasiosta ja abfraktiosta, sekä myös niiden hoidosta ja ehkäisystä. Tutkielmassa käsitellään lisäksi hampaiston kulumisen etiologisia tekijöitä, joihin kuuluvat muun muassa syömishäiriöt Anorexia nervosa ja Bulimia nervosa. Katsauksessa käsitellään myös kuluneen purennan kuntouttamista asiantuntijahoidon avulla.

Impact of the ego-dystonic nature of obsessions on treatment outcome in eating disorders

Il s'agit d'une hypothèse largement répandue que l’égo-dystonie et l’égo-syntonie caractérisent les obsessions dans les troubles des conduites alimentaires (TCA) et que ces facteurs sont cliniquement pertinents pour la conceptualisation et le traitement des TCA. Cependant, les résultats empiriques sur ce sujet sont rares. Compte tenu du chevauchement reconnu entre les TCA, notamment l'anorexie et la boulimie (BN), et le trouble obsessionnel-compulsif (TOC) dans la phénoménologie et les caractéristiques psychologiques, un programme de thérapie cognitive basée sur les inférences (TBI) de 24 semaines, démontré efficace dans le traitement des TOC, a été adapté pour traiter les TCA. La recherche sur le TOC suggère que la transformation des pensées intrusives en obsessions est liée à la mesure dans laquelle les pensées intrusives menacent des perceptions fondamentales du soi et de l’identité. Cette thèse a pour objectif d'examiner le lien entre l’égo-dystonie et les TCA. Pour se faire, nous avons exploré le lien entre la nature égo-dystone des obsessions chez les patients souffrant d'un TCA et la peur de l'image de soi. Nous avons également étudié la relation entre la sévérité des symptômes TCA et l’égo-dystonie dans les obsessions. En outre, nous avons investigué les différences dans la présence de pensées égo-dystones et de peur face à son identité entre des sujets non-cliniques et des personnes atteintes d’un TCA. Enfin, nous avons comparé le degré d’égo-dystonie dans les pensées de personnes atteintes d’un TCA à celui dans les pensées d’individus souffrant d’un TOC. L’égo-dystonie dans les pensées a été mesurée par l'Ego Dystonicity Questionnaire (EDQ) et le degré de peur face à l’identité a été mesuré par le Fear of Self Questionnaire (FSQ) d’une part dans un échantillon de femmes souffrant d’un TCA (n = 57) et d’autre part dans un échantillon de participantes non-cliniques (n = 45). Les résultats révèlent que l’égo-dystonie et la peur face à l’identité étaient fortement corrélées à la fois dans l’échantillon clinique et non-clinique. Les scores de l’EDQ n’étaient pas significativement corrélés à la sévérité des symptômes TCA à l'exception de la sous-échelle d’irrationalité de l’EDQ qui était fortement associée à la sévérité des comportements compulsifs compensatoires. Les participantes souffrant d'un TCA avaient des scores significativement plus élevés à l’EDQ et au FSQ que les sujets non-cliniques. Ensuite, une étude de cas décrit l’application du programme de thérapie cognitive TBI pour une femme de 35 ans avec un diagnostic de BN. La pathologie TCA s’est significativement améliorée au cours de la TBI et six mois suivant la thérapie. Cette étude de cas met en évidence l'importance de cibler les idées surévaluées, les doutes et le raisonnement face au soi et à l’identité dans le traitement psychologique pour les TCA. Enfin, l’objectif final de cette thèse était d’examiner les changements au niveau (1) des symptômes TCA, (2) du degré d’égo-syntonie dans les obsessions, et (3) des mesures de peur face à l’identité, de motivation, d’humeur et d’anxiété au cours de la TBI et au suivi post six mois. L’égo-dystonie, la peur face à l’identité, les symptômes TCA et le stade motivationnel ont été mesurés chez 15 femmes souffrant de BN au cours du traitement et six mois après la TBI. Quatre vingt pourcent de l’échantillon, soit 12 des 15 participantes, ont démontré une diminution cliniquement significative des symptômes TCA et 53% ont cessé leurs comportements compensatoires au suivi post six mois. Les retombées cliniques relatives au traitement des TCA sont discutées.

Narrative development and supported employment of persons with severe mental illness

Essai présenté à la Faculté des arts et des sciences en vue de l’obtention du grade de Doctorat en psychologie option psychologie clinique

Cognitive behaviour therapy for eating disorders

The eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.

BODY DYSMORPHIC DISORDER IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE and CLINICAL CORRELATES

Background The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.

Effects of eating disorders on oral fungal diversity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)